Prevalence of Osteoporosis in Osteoarthritic Patients Undergoing Total Hip or Total Knee Arthroplasty

Abstract

Objective-To determine the prevalence of osteoporosis in osteoarthritic patients undergoing total hip or total knee arthroplasty.Design-Cross-sectional study. Setting-The Specialized Outpatient Rehabilitation Service's (SORS) Pre-surgical ArthroplastyService located at the Chedoke Hospital, Hamilton Health Sciences, Hamilton, ON, Canada. Participants-SORS outpatients (N=364), from the period of March 2006 to March 2007. Interventions-Not applicable.Main Outcome Measures-Prevalence of osteoporosis was determined by review of a selfreported survey, and defined by (1) self-reported diagnosis of osteoporosis, (2) history of fragility fracture (defined by a bone fracture occuring as a result of a fall from standing height or less after the age of 50), or (3) current treatment for osteoporosis using bisphosphonates.Results-Of the study cohort, 26% were classified as having osteoporosis, according to our criteria. Of the patients with self-reported osteoporosis or a history of fragility fractures, only 37% and 17% reported current treatment with bisphosphonates, respectively.Conclusions-Osteoporosis is common in the osteoarthritic arthroplasty population, with a prevalence at least equal to that in the general population. Due to the self-reported nature of the study, the prevalence of osteoporosis in this population is likely significantly higher. Results from this study indicate need for further research, specifically in formal assessment for osteoporosis in patients undergoing a joint replacement. Keywords CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptThe number of joint replacements performed in north America is on the rise, and will continue to increase as the population ages. 1 The primary reason for hip and knee replacements is OA, caused by a wide variety of factors, including birth defects, excess weight, joint fractures, or other injuries that can damage cartilage. The demographic of patients requiring joint replacements of the knee and hip includes primarily older women. 1 It is also older women who are at the highest risk of osteoporosis and therefore of fragility fractures. 2 Furthermore, the insertion of an implant can change the stresses and strains that a bone experiences, possibly stimulating bone remodeling and resorption, leading to a decrease in bone density postsurgery. 3 Patients at risk for osteoporosis should be screened for this condition, and where applicable, treated with the appropriate medications and supplements. 2 The purpose of this study was to determine the prevalence of osteoporosis in a sample of prearthroplasty patients. METHODSOur patient population was obtained from the Specialized Out-patient Rehabilitation Service's Pre-surgical Arthroplasty Service located at the Chedoke site, Hamilton Health Sciences, Hamilton, Ontario. This service is available to prearthroplasty patients referred by an orthopedic surgeon. Its purpose is to educate, to facilitate early postoperative discharge and community reintegration, and to prevent acute care readmission. Dat...

Importance of Routine Bone Mineral Density Screening Prior to Elective Total Joint Replacement

“…L ow bone mineral density (BMD) appears to be common in patients undergoing total joint replacement (TJR), with up to two thirds and one third meeting criteria for osteopenia and osteoporosis, respectively. [1][2][3][4][5][6][7][8][9] Emerging data raise concerns that low BMD may increase the risk of intraoperative and postoperative complications in patients undergoing TJR. In a study of total ankle arthroplasty, low tibial BMD, as measured by Hounsfield units, from preoperative ankle computed tomography scan was associated with a higher risk for periprosthetic fracture (P=.018), with all intraoperative fractures occurring in patients with tibial Hounsfield units less than 200.…”

Intermittent Parathyroid Hormone Enhances Cancellous Osseointegration of a Novel Murine Tibial Implant

“…The quantity and quality of cancellous bone vary widely among individuals. Many patients are not considered candidates for cementless total knee arthroplasty because of concerns about insufficient cancellous bone in the proximal part of the tibia [13][14][15][16] . Biological enhancement of cancellous bone quantity and osseointegration would provide one mechanism to improve the outcomes of cementless total knee arthroplasty.…”

Underestimated Fracture Probability in Patients With Unilateral Hip Osteoarthritis as Calculated by FRAX

“…Others detected no correlation between BMD at OA sites and at sites distant from the osteoarthritic site without OA. (36, 18, 37). Our previous studies showed that women with unilateral hip OA have lower BMD levels on the contralateral side, with discordance in osteoporosis classification according to BMD measures (15, 20).…”

“…A further analysis of the characteristics in study subjects showed that those with both OA and OP had significantly lower body weight and BMI, and were older than those without OP (16). Subsequent reports confirmed that 20% to 29% of men and women with advanced OA have occult OP (17, 18, 19). …”